DULLES GOLF ACADEMY
"SWING ANALYSIS BY MAIL"

Chuck R. Will
PGA Director of Instruction
(703) 932-0537
Ship to info : (if different than student profile form)

Name:______________________________________________________________________________

Address:____________________________________________________________________________

City:______________________________________ State:_____________ Zip Code:_______________

Daytime Telephone: _________________________ Evening Telephone: _________________________


Enclosed Swings on:

     Mini-DV Tape


Please check the following service if requested:

    "Swing View Pro" Student CD ROM with Professional's Critiques, Corrections and Drills...$39.95                                   Shipping and Handling..........................................................................$ 5.00

           Total .......................................................................................................................$44.95


Method of payment:

  • Check enclosed made payable to: Dulles Golf Center
  • Please charge my Amex Visa Mastercard Discover

Name as it appears on the card ________________________________________________

Card # _______________________________________________ Expiration ______/______

Signature ____________________________________________ Date _______/_______2005